ESPN 51th Annual Meeting

ESPN 2018


 
CANACINUMAB EXPERIENCE IN RENAL TRANSPLANTATION IN AN ADOLESCENT DIAGNOSED WITH FAMILIAL MEDITERRANEAN FEVER AND AMILOIDOSIS
BELDE KASAP DEMIR 1 ÖNDER YAVAŞCAN 2 DEMET ALAYGUT 2 CANER ALPARSLAN 2 EREN SOYALTIN 2 SEÇIL ARSLANSOYU ÇAMLAR 2 FATMA MUTLUBAŞ 2

1- IZMIR KATIP ÇELEBI UNIVERSITY DEPARTMENT OF PEDIATRICS DIVISION OF NEPHROLOGY, IZMIR, TURKEY
2- IZMIR TEPECIK TRAINING AND RESEARCH HOSPITAL DEPARTMENT OF PEDIATRICS DIVISION OF NEPHROLOGY, IZMIR, TURKEY
 
Introduction:

There are limited reports in the literature about anti-IL1 treatment in the renal transplantation (RTx) era. Anti-IL1 treatment was avoided or induction therapy was not used in most cases. We presented a RTx recipient, who received canacinumab (CAN) and concomittant anti-IL2 (basiliximab) treatment for induction. 

Material and methods:

 A 16-year-old adolescent girl was diagnosed with FMF at the age of 6. Due to amyloidosis and unresponsiveness to colchicine, CAN was started as 2 mg/kg/8 weeks at the age of 13. She was put on peritoneal dialysis for the last 3 years. 

Results:

5 weeks after the last dose of CAN, she received a living unrelated kidney with 5 mismatches in another center. Basiliximab was used at post-tx day 0 and 4 and she received CAN dose 1 week after tx when she had a severe abdominal pain. When she was admitted to our center 2 weeks after tx, she had fever, piuria and increased serum creatinine levels and was on prednisolon, everolimus and mycophenolate mophetil treatment. She received meropenem for urinary tract infection. She had tachypnea and rales on ausculatation 6 days later and diagnosed with pneumoniae and teicoplanin was added. Although infections were treated, serum creatinine did not decrease to basal levels. Biopsy was performed, which was compatible with both acute cellular rejection and pyelonephritis. She received 3 doses of pulse methylprednisolone and everolimus was switched to tacrolimus targeting highest limits. She did not face with any other problem in the following 8 months and serum creatinine levels decreased to basal levels.

Conclusions:

 This is the first case in the literature receiving concomittant IL1 and IL2 supression at the time of Rtx. Care must be taken as institution of both agents may potentialize the immunosuppression in the early post-tx period.